Brain Bleeds in Preemies Raise Risk of Long-Term Visual Impairment

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Severe brain bleeding in premature infants can lead to long-term vision problems, according to researchers at the University of Bristol in the United Kingdom.¹

Study rationale. Intraventricular hemorrhage and ventricular dilation (IVHVD) is a common complication in premature infants. Severe IVHVD (grades 3 and 4) puts preterm infants at high risk for cognitive disabilities. An intervention known as DRIFT (drainage, irrigation, and fibrinolytic therapy) was developed as a method of “washing out” the ventricles. In a 2010 DRIFT study, the treatment was found to significantly improve cognitive outcomes.² A follow-up study of DRIFT, published in 2020, found the benefits of the intervention to be sus­tained over a 10-year period.³

Long-term follow-up. For this study, the U.K. re­searchers assessed the vision of the children in the DRIFT study. “The aim of our study was to examine a range of visual functions in a group of 10- and 11-year-old children who had experienced a severe complica­tion of premature birth in the perinatal period,” said lead author Cathy Williams, PhD. They also sought to discern whether there was any correlation between the children’s vision and the severity of their IVHVD and explored the associations between visual outcomes, cognitive outcomes, and the need for extra help in school.

Study details. The researchers evaluated the visual exams of 32 children who were part of the DRIFT study. Investigators were masked as to whether each child had experienced grade 3 versus grade 4 IVHVD.

Results. All of the children had one or more visual impairments. The median number of impairments per child who experienced grade 3 and 4 IVHVD was three and six, respectively. Each additional visual impairment per child was associated with increased need for edu­cational support at school, after adjusting for develop­mental age equivalence (odds ratio = 1.7, p = 0.015).

“We were surprised that all of the children had at least one vision problem, and several had multiple problems,” Professor Williams said. Moreover, she said, the researchers also observed that “the more vision problems a child had, the more likely they were to be receiving extra help at school, even after adjusting for IQ.”

Need for greater awareness. The study authors want clinicians to be aware of the high level of visual impair­ment present in children at least 10 years after severe IVHVD. They hope that developmental outcomes for such children might be improved if support for their visual impairments can be initiated as early as possible.

Professor Williams noted that neither parents nor pediatricians would be expected to know about these vision problems. “Babies who experience severe brain bleeds should have comprehensive vision checks as they grow. The child needs to be assessed by an eye care professional using appropriate and valid tests.”

—Patricia Weiser, PharmD

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1 Williams C et al. Dev Med Child Neurol. Published online June 23, 2022.

2 Whitelaw A et al. Pediatrics. 2010;125(4):e852-858.

3 Luyt K et al. Arch Dis Child Fetal Neonatal Ed. 2020;105(5):466-473.

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Relevant financial disclosures: Professor Williams—NIHR: S.

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